Everything You Never Knew You Wanted to Know about Going to the Bathroom (Part 2)

Last week we looked at some guidelines for what might be considered “normal” bladder habits. Today we will cover some guidelines for healthy bowel habits.

Norms:

The average adult will have 1-3 bowel movements per day or 5-9 per week.

Consistency of bowel movement should be firm and formed into logs.

Should occur with ease – no straining necessary – and only take a couple of minutes

You go less frequently:

a) You could be constipated. Mild constipation can occur for numerous reasons including deviating from your normal routine (ever been backed up on vacation??). If this persists though, try increasing water intake and fiber first. If that doesn’t help, you may need to try adding a probiotic to your diet or considering using a magnesium supplement like Natural Calm. If these over the counter products don’t seem to be helping, speak with your doctor or a pelvic floor therapist to rule out other possible causes.

b) You aren’t eating enough. This can be a problem for two reasons. One, when you aren’t eating enough calories, you likely are not getting enough fiber. Two, sometimes thirst and hunger pangs get a little mixed up in the brain. You may be inadvertently ignoring your body telling you it’s thirsty when you think you are ignoring a hunger pain. Consulting with a dietitian can be helpful to make sure your dietary needs are being met.

c) You frequently delay going to the restroom when you feel the urge. One of the roles of the colon is to reabsorb water from stool as it passes through the colon. When we delay the urge, the stool sits in the colon longer than it was supposed to. This leads to harder to pass stool too, which comes with a whole host of other issues.

d) Check your medications. Iron and pain pills are often culprits, but many other medications list constipation as a side effect. Check the side effects of any medications you are taking and discuss with your doctor. There may be an alternative medication that will not have this unintended effect.

You go more frequently:

a) First, what is the consistency of your stool? If you are frequently having loose bowel movements (see the chart below), it can be a sign that something may be off in your diet. You can try adding probiotics to your diet, but for some people this can increase symptoms of loose stool. Your best bet is to discuss this with your doctor. But, don’t wait as there can be side effects from long-term bouts of diarrhea.

b) You are taking a stool softener or laxative. There are many conditions that make it necessary to take these medications at times, but unfortunately, they can disrupt the body’s normal mechanisms and lead to dependence (in the case of laxatives). Discuss these or any other medications with the prescribing physician if you suspect medication may be related.

c) Pelvic floor dysfunction. This one can be tricky. Sometimes patients with pelvic floor dysfunction have less bowel movements, other times they find they have frequency with little volume. Do you have tense pelvic floor muscles? Weak pelvic floor muscles? Both can be a factor. Consulting a pelvic floor therapist can help determine what factors play a role for you.

You frequently strain:

a) Bad posture. Yep, that’s right. You even need good posture in the bathroom. So, what is good toileting posture? Well, squatting is ideal, but that’s not realistic for most of us. Simulating a squatting position is the next best thing. Buy a Squatty Potty, put your feet up on the side of the tub or even use a small step stool – just get those knees higher than your hips and lean forward slightly. This position is like magic for reducing minor constipation and straining because it actually puts a muscle called puborectalis (one of the key muscles responsible for bowel continence) in a relaxed position, straightening the colon and reducing internal resistance. [Even if you don’t normally strain, I highly recommend this position. Those who have tried it never go back. Trust me. Try it.]

b) Again, pelvic floor dysfunction can be a culprit. Even in the optimal position on the toilet, some people carry tension in the pelvic floor that makes it extremely difficult to pass stool. Straining is a no-no however for your long-term well-being. It increases the risk of hemorrhoids, varicose/spider veins and can lead to more serious pelvic floor dysfunction like pelvic organ prolapse.

Just like some people may suffer from urinary leakage, not being able to hold back gas or having stool leakage can be the first sign that something is “not quite right” in the pelvic floor. Other signs of pelvic floor dysfunction and constipation are painful bowel movements, feeling like you aren’t completely emptying when you have a bowel movement, bloating and abdominal cramps. If you are having any of these symptoms, consult with your pelvic floor therapist. We are here to help, and no amount of detail is too great! You have every right to feel comfortable in your skin and no one should ever feel the insecurity that these types of issues can bring.

Final Thoughts

Way more than you ever knew you wanted to know, right? I thought so.

I said this last week, but it bears repeating: norms are based on averages and averages include people on both ends of the spectrum – high and low. If you don’t fall perfectly into the ranges above or find your stool consistency is a little off one day, don’t freak out. It’s always good to have an idea of what your norm is. This can help you easily recognize when something is off and nip potential problems in the bud!

For more information about healthy habits or to set up an appointment with a pelvic floor therapist or dietitian. Give us a call. We are happy to help!

Thanks for reading!

Heather Draper, PT, DPT

Heather Draper is a physical therapist with Functionize Health & Physical Therapy. She specializes in treating patients with a variety of pelvic health conditions as well as low back, hip and SI pain. She earned her doctorate in physical therapy from the University of North Georgia where she participated in research related to diastasis recti causes, effects and treatment. Heather’s email is heather@functionizehealth.com. For more information visit www.functionizehealth.com.